Week 2 Valvular Disorders and Pulmonary Embolism

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respirations of 42 breaths/min. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient's health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowler's position.

ANS: D The patient has symptoms consistent with a pulmonary embolism (PE). Elevating the head of the bed will improve ventilation and gas exchange. The other actions can be accomplished after the head is elevated (and O2 is started). A spiral CT may be ordered by the health care provider to identify PE. Anticoagulants may be ordered after confirmation of the diagnosis of PE.

The nurse assesses a patient with valvular heart disease. The nurse recalls that the absence of what heart sound is indicative of aortic valve stenosis? Absence of S 1 Absence of S 2 Absence of S 3 Absence of S 4

Absence of S 2 Rationale Aortic stenosis occurs as the result of rheumatic fever and is characterized by a diminished or absent S 2. A diminished or absent S 1, S 3, or S 4 is associated with aortic valve regurgitation.

Which is a secondary cause of restrictive cardiomyopathy? Amyloidosis Aortic stenosis Muscular dystrophy Coronary artery disease

Amyloidosis Rationale Amyloidosis is the deposition of a protein, amyloid, that can lead to restrictive cardiomyopathy as a result of the buildup of amyloid deposits in the heart affecting its shape and function. Aortic stenosis causes hypertrophic cardiomyopathy. Muscular dystrophy and coronary heart disease cause dilated cardiomyopathy.

While auscultating a patient who underwent trauma, the nurse auscultates a quick, strong heartbeat that collapses immediately. The patient has severe dyspnea and describes the chest pain as 8 out of 10 on the pain scale. Which condition does the nurse suspect? Aortic valve stenosis Mitral valve stenosis Aortic valve regurgitation Mitral valve regurgitation

Aortic valve regurgitation Rationale A quick, strong beat that collapses immediately is known as water-hammer pulse. Water-hammer pulse, dyspnea, and chest pain due to trauma indicate aortic regurgitation (AR). Aortic stenosis (AS) is characterized by angina, exertional dyspnea, syncope, and left ventricular failure. Mitral valve stenosis involves exertional dyspnea, hoarseness, hemoptysis, chest pain, and seizures. Mitral valve regurgitation is associated with weakness, fatigue, palpitations, and dyspnea.

A patient is admitted to the hospital with a diagnosis of acute mitral valve regurgitation. What is the priority nursing intervention? Auscultate the lung sounds. Observe for bloody sputum. Assess for water-hammer pulse. Palpate lower extremities for edema.

Auscultate the lung sounds. Rationale Auscultation of the lung sounds is the priority nursing intervention in acute mitral valve regurgitation. In acute mitral valve regurgitation there is a rapid increase in left atrial pressure and volume, which leads to pulmonary congestion, resulting in pulmonary edema and possible cardiogenic shock. Hemoptysis can occur with mitral valve stenosis, not acute mitral valve regurgitation. Lower extremity edema is a manifestation of tricuspid stenosis. Water-hammer pulse is a manifestation of chronic, severe aortic valve regurgitation.

Which type of murmur is observed in patients with chronic aortic valve regurgitation? Diastolic murmur Austin Flint murmur Holosystolic murmur Loud midsystolic murmur

Austin Flint murmur Rationale An Austin Flint murmur occurs in patients with chronic aortic valve regurgitation. Mitral valve stenosis involves diastolic murmur. Holosystolic murmur occurs in patients with mitral valve prolapse. Loud midsystolic murmur occurs in patients with tricuspid and pulmonic stenosis.

The nurse is caring for an older patient that is diagnosed with pulmonic stenosis. The nurse anticipates that which type of conservative therapy may be prescribed? Annuloplasty Balloon valvuloplasty Mitral commissurotomy Sapien Transcatheter Heart Valve (THV)

Balloon valvuloplasty Rationale Balloon valvuloplasty or percutaneous transluminal balloon valvuloplasty (PTBV) is generally indicated for older adults and for those who are poor surgery candidates. PTBV is used for mitral, tricuspid, and pulmonic stenosis. Annuloplasty is the reconstruction of annulus that is beneficial in patients with mitral or tricuspid regurgitation. Mitral commissurotomy or valvulotomy is used in patients with pure mitral stenosis. Sapien Transcatheter Heart Valve (THV) is beneficial in patients with atrial stenosis.

The nurse is caring for a patient with valvular heart disease who experiences atrial dysrhythmias. The nurse anticipates a prescription for which type of medication? Nitrate Positive inotrope Calcium channel blocker Angiotensin-converting enzyme (ACE) inhibitor

Calcium channel blocker Rationale Atrial dysrhythmia is an irregular heartbeat that occurs in the atrium. Calcium channel blockers dilate arteries by reducing calcium flux into the cells, which increases myocardial oxygen supply and prevents atrial dysrhythmias. Nitrates and ACE inhibitors are vasodilators that are used in the treatment of heart failure. Positive inotropes are used to treat heart failure in patients with valvular heart disease.

The nurse assesses a patient and suspects acute mitral valve regurgitation (MR). Which symptoms support the nurse's suspicion? Select all that apply. Palpitations Cool extremities Peripheral edema Thready, peripheral pulses Audible third heart sound (S 3)

Cool extremities Thready, peripheral pulses Rationale Mitral regurgitation is a valvular heart disease that causes backward flow of blood from the left ventricle to the left atrium due to incomplete valve closure during systole. Acute mitral regurgitation is characterized by thready peripheral pulses and cool extremities. Palpitations, peripheral edema, and an audible third heart sound (S 3) are symptoms of chronic mitral regurgitation.

Which type of surgical therapy utilizes cardiopulmonary bypass? Annuloplasty Closed procedure Balloon valvuloplasty Direct vision procedure

Direct vision procedure Rationale Direct vision procedure or open procedure is the surgical therapy that involves the use of cardiopulmonary bypass. Annuloplasty is the reconstruction of the annulus of a valve, and it does not require cardiopulmonary bypass. Closed procedure requires the insertion of transventricular dilator through the left ventricular apex into the mitral valve. Balloon valvuloplasty involves threading a balloon-tipped catheter from the femoral artery or vein into the stenotic valve.

Which medication is prescribed to decrease preload in patients with dilated cardiomyopathy? Captopril Metoprolol Furosemide Spironolactone

Furosemide Rationale Furosemide is a diuretic that decreases preload in patients with dilated cardiomyopathy. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that reduces afterload. Metoprolol is an adrenergic blocker that controls neurohormonal stimulation in patients with heart failure. Spironolactone is a diuretic that controls neurohormonal stimulation in patients with heart failure.

The nurse recalls that which are the main characteristics of hypertrophic cardiomyopathy (CMP)? Select all that apply. Impaired systole Impaired diastole Atrial hypertrophy Massive ventricular hypertrophy Rapid, forceful contraction of the left ventricle

Impaired diastole Massive ventricular hypertrophy Rapid, forceful contraction of the left ventricle Rationale The main characteristics of hypertrophic cardiomyopathy include massive ventricular hypertrophy, impaired diastole, and rapid, forceful contractions of the left ventricle. Atrial hypertrophy and impaired systole are not characteristic of hypertrophic cardiomyopathy; this disease process involves the left ventricle.

Which statement is true regarding hypertrophic cardiomyopathy? It involves impaired diastole. Its only symptoms are dyspnea and fatigue. It is associated with a thin and fragile ventricular wall. It is characterized by moderate to severe cardiomegaly.

It involves impaired diastole. Rationale Hypertrophic cardiomyopathy is asymmetric left ventricular hypertrophy without ventricular dilation. Impaired filling (diastole) is a main characteristic. It is associated with a thickened intraventricular septum and ventricular wall. Hypertrophic cardiomyopathy is characterized by exertional dyspnea, fatigue, angina, syncope, and palpitations; dyspnea and fatigue only occur in restrictive cardiomyopathy. Cardiomegaly is mild to moderate in hypertrophic cardiomyopathy.

The nurse is preparing a discharge teaching plan for a patient admitted with restrictive cardiomyopathy. Which instruction should the nurse include in the plan? Follow a normal sodium diet. Drink three to four glasses of water daily. Maintain a reasonable weight and avoid large meals. Report signs of heart failure to the health care provider, which include weight loss.

Maintain a reasonable weight and avoid large meals. Rationale The patient should maintain a reasonable weight and avoid large meals. The patient should follow a low-sodium diet and read all product labels for sodium content. The patient should drink six to eight glasses of water a day unless fluids are restricted. Weight gain is a sign of heart failure.

The nurse finds diastolic murmurs in a patient who says, "I'm finding it hard to breathe, and sometimes I cough up blood." What condition does the nurse suspect? Mitral valve stenosis Aortic valve stenosis Mitral valve prolapse Aortic valve regurgitation

Mitral valve stenosis Rationale Coughing up of blood from the bronchi, larynx, or lungs is known as hemoptysis, and difficulty breathing is dyspnea. Hemoptysis, dyspnea, and diastolic murmurs indicate mitral valve stenosis. Aortic valve stenosis is characterized by angina, dyspnea, syncope, and left ventricular failure. Mitral valve prolapse is an abnormality of the mitral valve leaflets and the papillary muscles that involves dysrhythmias, ventricular tachycardia, palpitations, light-headedness, and dizziness. Aortic valve regurgitation is associated with abrupt dyspnea, chest pain, left ventricular failure, and cardiogenic shock.

An 80-year-old patient who is a poor surgery candidate is diagnosed with aortic stenosis. The nurse anticipates that what procedure will likely be recommended? Annuloplasty Aortic valve replacement Open commissurotomy (valvulotomy) procedure Percutaneous transluminal balloon valvuloplasty (PTBV) procedure

Percutaneous transluminal balloon valvuloplasty (PTBV) procedure Rationale The PTBV procedure is generally indicated for an older patient who is a poor surgery candidate. Annuloplasty is an option for patients with mitral or tricuspid regurgitation. An open commissurotomy procedure is used for mitral stenosis. Valve replacement may be required for mitral, aortic, tricuspid, and occasionally pulmonic valve disease.

A patient with mitral valve stenosis presents with hemoptysis. The nurse suspects that the symptom is caused by what? Atrial fibrillation Pulmonary hypertension Decreased cardiac output Atrial enlargement pressing on the laryngeal nerve

Pulmonary hypertension Rationale Pulmonary hypertension causes hemoptysis or bleeding in the lungs and the coughing up of blood due to increased pressure in the pulmonary circulation. Atrial fibrillation in patients with mitral valve prolapse results in fatigue and palpitations. Decreased cardiac output results in chest pain in patients with mitral valve prolapse. Hoarseness occurs due to atrial enlargement pressing on the laryngeal nerve in patients with mitral valve prolapse.

Which diagnostic study is used to assess congenital heart disease in a patient? Chest x-ray Doppler color-flow imaging Real time 3-D echocardiography Computerized tomography scan

Real time 3-D echocardiography Rationale Real-time 3-D echocardiography is used to assess mitral valve defects and congenital heart disease. Chest x-ray reveals heart size, altered pulmonary circulation, and valve calcification. Doppler color-flow imaging and transesophageal echocardiography help diagnose and monitor valvular heart disease progression. Computerized tomography scan with contrast gold helps diagnose aortic disorders.

Which diagnostic study is used to diagnose mitral valve prolapse? Electrocardiogram Cardiac catheterization Real-time 3-D echocardiography CT scan of the chest with contrast

Real-time 3-D echocardiography Rationale Echocardiogram is the diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. Echocardiogram is used to monitor progression of valvular heart disease. A CT scan of the chest with contrast is the gold standard for evaluating aortic disorders. An electrocardiogram is used to identify heart rate, rhythm, ischemia, or ventricular hypertrophy. Cardiac catheterization is used to detect pressure changes in the cardiac chambers.

The nurse assessing a patient with mitral valve stenosis will likely find symptoms primarily associated with what cardiac change? Reduced lung compliance Inadequate filling of the right ventricle Increased pressure in the left ventricle Decreased pulmonary vascular pressure

Reduced lung compliance Rationale The primary symptom of mitral stenosis is exertional dyspnea caused by a reduced lung compliance. Increased pulmonary vascular pressure results due to increased left atrial pressure and volume increase. Increased left ventricular pressure may be seen with aortic stenosis. Inadequate filling of the right ventricle may be due to atrial fibrillation or atrial flutter.

What EKG rhythm is related to pulmonary embolism?

Sinus tachycardia

A multiple gated acquisition (MUGA) scan has been prescribed to a patient with cardiac problems to determine what? The patient's ejection fraction (EF) The presence of conduction disturbances The effectiveness of dilated cardiomyopathy The presence of infectious organisms in the heart tissue

The patient's ejection fraction (EF) Rationale A multiple gated acquisition nuclear scan determines ejection fraction. Ejection fraction less than 20 percent is associated with a 50 percent mortality rate within a year. Conduction disorders like tachycardia, bradycardia, and dysrhythmias are diagnosed by electrocardiogram. Endomyocardial biopsy at the right side of the heart helps identify infectious organisms in heart tissue. Doppler echocardiography helps evaluate the effectiveness of dilated cardiomyopathy.

A patient that has undergone valve replacement takes warfarin. The patient asks the nurse why regular international normalized ratio (INR) tests are prescribed. What explanation should the nurse give to emphasize the importance of this test? Select all that apply. To prevent endocarditis To determine proper dosage To prolong durability of valves To determine patency of valves To determine adequacy of therapy

To determine proper dosage To determine adequacy of therapy Rationale The INR must be checked regularly if the patient is on anticoagulation therapy to determine the proper dosage. A high or low INR may require the dose to be adjusted. INR is also tested to determine the adequacy of anticoagulation. If the anticoagulant is not adequate, blood clots may form. If anticoagulation is more than adequate, there is an increased risk of bleeding. The test cannot indicate endocarditis or patency or durability of valves.

Which type of valvular heart disease occurs almost exclusively in patients that abuse drugs intravenously? Tricuspid stenosis Pulmonic stenosis Aortic valve stenosis Mitral valve stenosis

Tricuspid stenosis Rationale Tricuspid stenosis is the disease of the tricuspid valve that occurs in patients who abuse drugs intravenously or who have had rheumatic fever. Pulmonic stenosis is congenital. Aortic valve stenosis occurs due to rheumatic fever. Mitral valve stenosis occurs due to rheumatic heart disease.

It is determined that a patient with advanced dilated cardiomyopathy (CMP) is not a candidate for heart transplantation. The nurse anticipates a prescription for what treatment? Atrioventricular pacemaker Ventricular assist device (VAD) Ventriculomyotomy and myectomy surgery Percutaneous transluminal septal myocardial ablation

Ventricular assist device (VAD) Rationale Patients with dilated cardiomyopathy may benefit from nondrug therapies. A VAD allows the heart to rest and recover from acute heart failure. It also may serve as a bridge to heart transplantation. Additionally, cardiac resynchronization therapy and an implantable cardioverter-defibrillator are used in appropriate patients. Atrioventricular pacemaker, ventriculomyotomy and myectomy surgery, and percutaneous transluminal septal myocardial ablation are appropriate for hypertrophy cardiomyopathy.

The nurse is caring for a patient with mitral regurgitation. Referring to the figure below, where should the nurse listen to best hear a murmur typical of mitral regurgitation? a. 1 b. 2 c. 3 d. 4

ANS: D Sounds from the mitral valve are best heard at the apex of the heart, fifth intercostal space, midclavicular line.

Which questions are appropriate for the nurse to ask to assess the cognitive-perceptual patterns of a patient diagnosed with valvular heart disease? *Select all that apply.* "Do you experience angina?" "Do you experience fainting?" "Do you experience dizziness?" "Do you experience orthopnea?" "Do you experience atypical chest pain?"

"Do you experience angina?" "Do you experience atypical chest pain?" Rationale While assessing the effect of valvular heart disease on a patient's cognitive-perceptual pattern, it is appropriate to ask if the patient has angina and atypical chest pain. Cognitive perceptual pattern understands how a patient perceives and responds to sensory input. Angina and chest pain indicates the presence of an effect on nociceptors that send signals to the brain and spinal cord. The sensation is known by the sensation-generating mechanism defined by the modality of receptors. Asking the patient about fainting, dizziness, and orthopnea helps in assessing the activity-exercise functional health pattern.

A patient has undergone surgery for a valve replacement. Which statements indicate that the patient understands the instructions from the nurse? Select all that apply. "I should wear a Medic Alert device." "I will start a vigorous aerobic exercise program." "Valve surgery has completely cured my disease." "I will need to take antibiotics when I have my teeth extracted." "I should contact my health care provider if I have a respiratory infection."

"I should wear a Medic Alert device." "I will need to take antibiotics when I have my teeth extracted." "I should contact my health care provider if I have a respiratory infection." Rationale It is advisable for this patient to wear a Medic Alert device to provide information in case of an emergency. Antibiotic prophylaxis prior to invasive dental procedures (such as extraction) is necessary to prevent endocarditis. Respiratory infections should be treated with antibiotics because some microorganisms may damage the valves of the heart. Also, valve surgery only relieves the symptoms and does not cure the disease; therefore, regular follow-up is important to monitor the disease progression. Strenuous physical exercise should be avoided because the valve may be unable to accommodate the associated increase in cardiac output. The extent of physical exercise should be prescribed by the health care provider.

Which statement made by the nurse to a patient with cardiomyopathy regarding home care instructions needs correction? "Avoid diet pills." "Eat a low-sodium diet." "Increase your caffeine consumption." "Report increased fatigue to your primary health care provider."

"Increase your caffeine consumption." Rationale Caffeine contains stimulants that stimulate the heart, which results in irregular heart rhythms. Therefore patients with cardiomyopathy should avoid caffeine. The patient should avoid diet pills because they may contain stimulants. The patient should consume a low-sodium diet. The patient should report increased fatigue to the primary health care provider.

The nurse is providing discharge education to a patient with dilated cardiomyopathy (CMP). Which patient statement indicates the need for further teaching? "I may need to start taking a diuretic." "I may be given a prescription for nitroglycerin." "Most patients with this diagnosis respond well to treatment." "I should alternate periods of rest with required activities of daily living."

"Most patients with this diagnosis respond well to treatment." Rationale Dilated CMP does not respond well to therapy, and patients experience multiple episodes of heart failure (HF). Nitrates and diuretics decrease preload and may be prescribed. Alternating periods of rest with activity is needed to reduce the workload of the heart.

The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? a. The patient complains of chest pressure when ambulating. b. A loud systolic murmur is heard along the right sternal border. c. A thrill is palpated at the second intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

ANS: A Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.

The nurse is caring for a patient with aortic stenosis. Which assessment data obtained by the nurse would be most important to report to the health care provider? a. The patient complains of chest pressure when ambulating. b. A loud systolic murmur is heard along the right sternal border. c. A thrill is palpated at the second intercostal space, right sternal border. d. The point of maximum impulse (PMI) is at the left midclavicular line.

ANS: A Chest pressure (or pain) occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a patient with aortic stenosis. A PMI at the left midclavicular line is normal.

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. An appropriate nursing intervention for this patient would be to a. promote rest to decrease myocardial oxygen demand. b. teach the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. raise the head of the bed 60 degrees to decrease venous return.

ANS: A Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patient's temperature. c. Give the PRN acetaminophen (Tylenol). d. Notify the patient's health care provider.

ANS: A The patient's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature and notifying the health care provider are also appropriate actions but would not be done before listening for a rub. Acetaminophen (Tylenol) is not very effective for pericarditis pain, and an analgesic would not be given before assessment of a new symptom.

A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis. The patient reports that discomfort in the joints prevents favorite activities such as taking a daily walk and working on sewing projects. Based on these findings, which nursing diagnosis statement would be appropriate? a. Activity intolerance related to arthralgia b. Anxiety related to permanent joint fixation c. Altered body image related to polyarthritis d. Social isolation related to pain and swelling

ANS: A The patient's joint pain will lead to difficulty with activity. Although acute joint pain will be a problem for this patient, joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes. This patient did not provide any data to support a diagnosis of social isolation, anxiety, or altered body image.

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is most appropriate for the nurse to include? a. Arrange for placement of a long-term IV catheter. b. Monitor labs for levels of streptococcal antibodies. c. Teach the importance of completing all oral antibiotics. d. Encourage the patient to begin regular aerobic exercise.

ANS: A Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy to eradicate the bacteria, which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line. Rest periods and limiting physical activity to a moderate level are recommended during the treatment for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.

The nurse is caring for a 64-yr-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has 4+ peripheral edema. b. The patient has diffuse bilateral crackles. c. The patient has a loud systolic murmur across the precordium. d. The patient has a palpable thrill felt over the left anterior chest.

ANS: B Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

The nurse is caring for a 64-yr-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has 4+ peripheral edema. b. The patient has diffuse bilateral crackles. c. The patient has a loud systolic murmur across the precordium. d. The patient has a palpable thrill felt over the left anterior chest.

ANS: B Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? a. Fever, chills, and diaphoresis b. Urine output less than 30 mL/hr c. Petechiae on the inside of the mouth and conjunctiva d. Increase in heart rate of 15 beats/minute with walking

ANS: B Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output. Petechiae, fever, chills, and diaphoresis are symptoms of IE but are not caused by decreased cardiac output. An increase in pulse rate of 15 beats/min is normal with exercise.

A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the patient about the purpose of a. blood cultures. b. echocardiography. c. cardiac catheterization. d. 24-hour Holter monitor.

ANS: B Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization and 24-hour Holter monitor are not diagnostic procedures for pericarditis.

After receiving change-of-shift report on four patients, which patient should the nurse assess first? a. Patient with rheumatic fever who has sharp chest pain with a deep breath b. Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg c. Patient with infective endocarditis who has a murmur and splinter hemorrhages d. Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases

ANS: B Hypotension in patients with acute aortic regurgitation may indicate cardiogenic shock. The nurse should immediately assess this patient for other findings such as dyspnea, chest pain or tachycardia. The findings in the other patients are typical of their diagnoses and do not indicate a need for urgent assessment and intervention.

The nurse is assessing a patient with myocarditis before giving the scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider? a. Leukocytosis b. Irregular pulse c. Generalized myalgia d. Complaint of fatigue

ANS: B Myocarditis predisposes the heart to digoxin-associated dysrhythmias and toxicity. The other findings are common symptoms of myocarditis and there is no urgent need to report these.

During the assessment of a young adult patient with infective endocarditis (IE), the nurse would expect to find a. substernal chest pressure. b. a new regurgitant murmur. c. a pruritic rash on the chest. d. involuntary muscle movement.

ANS: B New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-yr-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-yr-old patient with tuberculosis (TB) who has four medications due in 15 minutes d. A 35-yr-old patient who was admitted with pneumonia and has a temperature of 100.2° F (37.8° C)

ANS: B Patients on bed rest who are immobile are at high risk for deep vein thrombosis (DVT). Sudden onset of shortness of breath in a patient with a DVT suggests a pulmonary embolism and requires immediate assessment and action such as O2 administration. The other patients should also be assessed as soon as possible, but there is no indication that they may need immediate action to prevent clinical deterioration.

To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. auscultate with the diaphragm of the stethoscope on the lower left sternal border. c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

ANS: B Pericardial friction rubs are best heard with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the presence of pulsus paradoxus, the nurse should a. subtract the diastolic blood pressure from the systolic blood pressure. b. note when Korotkoff sounds are auscultated during both inspiration and expiration. c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle. d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

ANS: B Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff sounds can be heard during only expiration and when they can be heard throughout the respiratory cycle. The other methods described would not be useful in determining the presence of pulsus paradoxus

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history focuses on a pertinent risk factor for rheumatic fever? a. "Do you use any illegal IV drugs?" b. "Have you had a recent sore throat?" c. "Have you injured your chest in the last few weeks?" d. "Do you have a family history of congenital heart disease?"

ANS: B Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor for rheumatic fever, and it would not be as pertinent when admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than rheumatic fever.

Which assessment finding in a patient who is admitted with infective endocarditis (IE) is most important to communicate to the health care provider? a. Generalized muscle aching b. Sudden onset right flank pain c. Janeway's lesions on the palms d. Temperature 100.7°F (38.1°C)

ANS: B Sudden onset of flank pain indicates possible embolization to the kidney and may require diagnostic testing such as a renal arteriogram and interventions to improve renal perfusion. The other findings are typically found in IE but do not require any new interventions

When developing a community health program to decrease the incidence of rheumatic fever, which action should the community health nurse include? a. Vaccinate high-risk groups in the community with streptococcal vaccine. b. Teach community members to seek treatment for streptococcal pharyngitis. c. Teach about the importance of monitoring temperature when sore throats occur. d. Teach about prophylactic antibiotics to those with a family history of rheumatic fever.

ANS: B The incidence of rheumatic fever is decreased by treatment of streptococcal infections with antibiotics. Family history is not a risk factor for rheumatic fever. There is no immunization that is effective in decreasing the incidence of rheumatic fever. Teaching about monitoring temperature will not decrease the incidence of rheumatic fever.

After receiving information about four patients during change-of-shift report, which patient should the nurse assess first? a. Patient with acute pericarditis who has a pericardial friction rub b. Patient who has just returned to the unit after balloon valvuloplasty c. Patient who has hypertrophic cardiomyopathy and a heart rate of 116 d. Patient with a mitral valve replacement who has an anticoagulant scheduled

ANS: B The patient who has just arrived after balloon valvuloplasty will need assessment for complications such as bleeding and hypotension. The information about the other patients is consistent with their diagnoses and does not indicate any complications or need for urgent assessment or intervention.

Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement? a. Administer ceftriaxone 1 g IV. b. Order blood cultures drawn from two sites. c. Give acetaminophen (Tylenol) PRN for fever. d. Arrange for a transesophageal echocardiogram.

ANS: B Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before starting antibiotic therapy to obtain accurate sensitivity results. The echocardiogram and acetaminophen administration also should be implemented rapidly, but the blood cultures (and then administration of the antibiotic) have the highest priority.

During discharge teaching with an older patient who had a mitral valve replacement with a mechanical valve, the nurse must instruct the patient on the a. use of daily aspirin for anticoagulation. b. correct method for taking the radial pulse. c. need for frequent laboratory blood testing. d. need to avoid any physical activity for 1 month.

ANS: C Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are most effective? a. Assess for the presence of a paradoxical pulse. b. Monitor for changes in the patient's sedimentation rate. c. Assess for the presence of jugular venous distention (JVD). d. Check the electrocardiogram (ECG) for ST segment changes.

ANS: C Because the most common finding on physical examination for a patient with chronic constrictive pericarditis is jugular venous distention, a decrease in JVD indicates improvement. Paradoxical pulse, ST segment ECG changes, and changes in sedimentation rates occur with acute pericarditis but are not expected in chronic constrictive pericarditis.

The nurse will plan discharge teaching about prophylactic antibiotics before dental procedures for which patient? a. Patient admitted with a large acute myocardial infarction b. Patient being discharged after an exacerbation of heart failure c. Patient who had a mitral valve replacement with a mechanical valve d. Patient being treated for rheumatic fever after a streptococcal infection

ANS: C Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.

When caring for a patient with infective endocarditis of the tricuspid valve, the nurse should monitor the patient for the development of a. flank pain. b. splenomegaly. c. shortness of breath. d. mental status changes.

ANS: C Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, changes in mental status, and splenomegaly would be associated with embolization from the left-sided valves.

A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

ANS: C Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system and immunosuppressive therapy is not needed.

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. An appropriate intervention by the nurse for this problem is to a. teach the patient to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. provide a fresh ice bag every hour for the patient to place on the chest. d. place the patient in Fowler's position, leaning forward on the overbed table.

ANS: D Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend to increase pericardial pain. Ice does not decrease this type of inflammation and pain.

A 21-yr-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient? a. Biologic valves will require immunosuppressive drugs after surgery. b. Mechanical mitral valves need to be replaced sooner than biologic valves. c. Lifelong anticoagulant therapy is needed after mechanical valve replacement. d. Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

ANS: C Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict decisions about career and childbearing in this patient. Mechanical valves are durable and last longer than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health care. Biologic valves do not activate the immune system and immunosuppressive therapy is not needed.

The home health nurse is visiting a 30-yr-old patient recovering from rheumatic fever without carditis. The nurse establishes the nursing diagnosis of ineffective health maintenance related to lack of knowledge regarding long-term management of rheumatic fever when the patient makes which statement? a. "I will need prophylactic antibiotic therapy for 5 years." b. "I can take aspirin or ibuprofen (Motrin) to relieve my joint pain." c. "I will be immune to future episodes of rheumatic fever after this infection." d. "I should call the health care provider if I am fatigued or have difficulty breathing."

ANS: C Patients with a history of rheumatic fever are more susceptible to a second episode. Patients with rheumatic fever without carditis require prophylaxis until age 20 years and for a minimum of 5 years. The other patient statements are correct and would not support the nursing diagnosis of ineffective health maintenance.

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 168/94 mm Hg c. Jugular venous distention (JVD) to jaw level d. Level 6 (0 to 10 scale) chest pain with a deep breath

ANS: C The JVD indicates that the patient may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis.

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV b. IV morphine sulfate 4 mg c. Oral ibuprofen (Motrin) 600 mg d. Oral acetaminophen (Tylenol) 650 mg

ANS: C The pain associated with pericarditis is caused by inflammation, so nonsteroidal antiinflammatory drugs (e.g., ibuprofen) are most effective. Opioid analgesics and acetaminophen are not very effective for the pain associated with pericarditis.

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

ANS: C The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia, which is a priority.

While caring for a 23-yr-old patient with mitral valve prolapse (MVP) without valvular regurgitation, the nurse determines that discharge teaching has been effective when the patient states that it will be necessary to a. take antibiotics before any dental appointments. b. limit physical activity to avoid stressing the heart. c. avoid over-the-counter (OTC) drugs that contain stimulants. d. take an aspirin a day to prevent clots from forming on the valve.

ANS: C Use of stimulant drugs should be avoided by patients with MVP because they may exacerbate symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.

The nurse is obtaining a health history from a 24-yr-old patient with hypertrophic cardiomyopathy (CMP). Which information obtained by the nurse is most important? a. The patient has a history of a recent upper respiratory infection. b. The patient has a family history of coronary artery disease (CAD). c. The patient reports using cocaine a "couple of times" as a teenager. d. The patient's 29-yr-old brother died from a sudden cardiac arrest.

ANS: D About half of all cases of hypertrophic CMP have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people. The information about the patient's brother will be helpful in planning care (e.g., an automatic implantable cardioverter-defibrillator [AICD]) for the patient and in counseling other family members. The patient should be counseled against the use of stimulant drugs, but the limited past history indicates that the patient is not currently at risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy but not for hypertrophic CMP.

The nurse obtains a health history from an older patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse is most focused on identifying a risk factor for IE? a. "Do you have a history of a heart attack?" b. "Is there a family history of endocarditis?" c. "Have you had any recent immunizations?" d. "Have you had dental work done recently?"

ANS: D Dental procedures place the patient with a prosthetic mitral valve at risk for IE. Myocardial infarction, immunizations, and a family history of endocarditis are not risk factors for IE.

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been effective? a. "I will avoid taking aspirin or other antiinflammatory drugs." b. "I can restart my exercise program that includes hiking and biking." c. "I will need to limit my intake of salt and fluids even in hot weather." d. "I will take antibiotics before my teeth are cleaned at the dental office."

ANS: D Patients with restrictive cardiomyopathy are at risk for infective endocarditis and should use prophylactic antibiotics for any procedure that may cause bacteremia. The other statements indicate a need for more teaching by the nurse. Dehydration and vigorous exercise impair ventricular filling in patients with restrictive cardiomyopathy. There is no need to avoid salt (unless ordered), aspirin, or nonsteroidal antiinflammatory drugs.

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder? a. A heart transplant should be scheduled as soon as possible. b. Elevating the legs above the heart will help relieve dyspnea. c. Careful compliance with diet and medications will prevent heart failure. d. Notify the health care provider about symptoms such as shortness of breath.

ANS: D The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation

Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit? a. Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome. b. Obtain a list of herbal medications used at home while admitting a new patient with pericarditis. c. Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy. d. Watch the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

ANS: D Under the supervision of registered nurses (RNs), UAPs check the patient's cardiac monitor and obtain information about changes in heart rate and rhythm with exercise. Teaching and obtaining information about home medications (prescribed or complementary) and selecting the best leads for monitoring patients require more critical thinking and should be done by the RN.

A patient with a history of rheumatic fever is diagnosed with mitral valve stenosis. The patient is scheduled for prosthetic valve replacement surgery. The nurse should inform the patient that what protective mechanism will be implemented after the surgery? Exercise plan to increase cardiac tolerance β-adrenergic blockers to control palpitations Immunosuppressive therapy to prevent rejection Antibiotic prophylaxis for dental manipulation involving the gums of the teeth

Antibiotic prophylaxis for dental manipulation involving the gums of the teeth Rationale The patient will need to use antibiotic prophylaxis for dental care to prevent endocarditis. Immunosuppressive therapy is not necessary. An exercise plan to increase cardiac tolerance is needed for a patient with heart failure. Taking β-adrenergic blockers to control palpitations is prescribed for mitral valve prolapse, not valve replacement.

The nurse is planning discharge teaching for a patient with cardiomyopathy. What instructions should be included in the plan? Select all that apply. Avoid alcohol. Balance activity and rest periods. Drink 2 to 4 glasses of water a day. Avoid vigorous isometric exercises. Consume food products with high sodium content.

Avoid alcohol. Balance activity and rest periods. Avoid vigorous isometric exercises. Rationale A patient with cardiomyopathy should avoid alcohol because it may increase blood pressure and can have adverse effects on the heart. Balance between activities and rest is essential to decrease systemic valvular resistance. Dehydration can increase systemic valvular resistance, which may result in obstruction to the forward flow of blood. Therefore it is important to drink six to eight glasses of water every day to avoid dehydration. Patients should avoid heavy lifting or vigorous isometric exercises. It is important to follow a low-sodium diet because it helps prevent water retention in the body.

The nurse should include which instructions when teaching a patient with mitral valve prolapse about self-care? Select all that apply. Avoid caffeine. Avoid all exercise. Avoid heavy lifting or isometric exercises. Avoid ephedrine in over-the-counter medications. Use antibiotics prophylactically prior to a procedure. Immediately report shortness of breath, fatigue, and palpitations.

Avoid caffeine. Avoid ephedrine in over-the-counter medications. Immediately report shortness of breath, fatigue, and palpitations. Rationale The nurse will teach a patient with mitral valve prolapse to immediately report shortness of breath, fatigue, palpitations, or other symptoms such as anxiety to the healthcare provider, or if necessary, activate the emergency response system. Avoiding caffeine and ephedrine will prevent heart palpitations. The patient is encouraged to begin or maintain an exercise program to maintain optimal health. The use of antibiotics prior to a procedure is not necessary with mitral valve prolapse. Instructing a patient to avoid heavy lifting or isometric exercises is reserved for patients with a symptomatic or a pathologic cardiac condition such as cardiomyopathy.

The nurse is planning discharge teaching for a patient with valvular heart disease. What instructions should the nurse include in the plan? *Select all that apply.* Avoid cigarettes. Take planned rest periods. Limit activities that cause fatigue. Undergo regular cardiac assessments. Continue with 30-40 minutes/day of strenuous exercise to build stamina.

Avoid cigarettes. Take planned rest periods. Limit activities that cause fatigue. Undergo regular cardiac assessments. Rationale Consumption of tobacco should be strictly avoided because it stimulates the heart. Rest periods should be planned to avoid exertion. Activities that cause fatigue or dyspnea should be limited. Regular cardiac assessment helps to monitor the disease progress and effectiveness of the treatment provided. The patient should be advised to avoid strenuous physical activities because damaged valves may not be able to properly cope with the increased cardiac output demand.

The nurse assesses a 70-year-old patient during a follow-up visit. The patient has progressive valvular disease caused by rheumatic fever. Which interventions are appropriate for the nurse to perform? Select all that apply. Encourage planned rest periods. Ensure ongoing prophylactic therapy. Encourage persistent physical exercise. Evaluate the effectiveness of medication. Discuss the recommendation for a mechanical valve replacement.

Encourage planned rest periods. Ensure ongoing prophylactic therapy. Evaluate the effectiveness of medication. Rationale When assessing a patient with progressive valvular disease caused by rheumatic fever, the nurse should ensure ongoing prophylaxis to prevent recurrence. The nurse should encourage the patient to plan rest periods and should evaluate the effectiveness of medication. The patient should avoid persistent physical exercise to prevent fatigue and dyspnea; instead, the patient should have an appropriate exercise plan to increase cardiac tolerance. It is preferable for patients over 65 years of age to undergo biologic valve replacement rather than mechanical valve replacement because the latter involves higher risk of bleeding from anticoagulants.

The nurse performs an international normalized ratio (INR) blood study for a patient two months after the patient underwent mitral valve replacement surgery. The patient has been receiving warfarin therapy since the surgery. The INR value is 3.1. The nurse should take what action? Prepare to administer a vitamin K injection. Maintain the patient at the same warfarin dose. Request a prescription for a higher dose of warfarin. Instruct the patient to stop taking the warfarin until the INR level decreases.

Maintain the patient at the same warfarin dose. Rationale International normalized ratio (INR) values of 2.5 to 3.5 are therapeutic for patients with mechanical valves, so it is not necessary to change the dose. The patient should not stop taking the warfarin or take a higher dose. Vitamin K is the antidote for warfarin, and it is not necessary to take because the INR is in a therapeutic range.

Which diagnostic study is used to diagnose mitral valve prolapse? Electrocardiogram Cardiac catheterization Real-time 3-D echocardiography CT scan of the chest with contrast

Real-time 3-D echocardiography Rationale Echocardiogram is the diagnostic study that is used to diagnose mitral valve prolapse. All echocardiograms are done in two or three dimensions. Echocardiogram is used to monitor progression of valvular heart disease. A CT scan of the chest with contrast is the gold standard for evaluating aortic disorders. An electrocardiogram is used to identify heart rate, rhythm, ischemia, or ventricular hypertrophy. Cardiac catheterization is used to detect pressure changes in the cardiac chambers.

Which type of cardiomyopathy impairs diastolic filling and stretch? Dilated cardiomyopathy Restrictive cardiomyopathy Takotsubo cardiomyopathy Hypertrophic cardiomyopathy

Restrictive cardiomyopathy Restrictive cardiomyopathy, the least common type of cardiomyopathy, impairs diastolic filling and stretch. Dilated cardiomyopathy involves diffuse inflammation and rapid degeneration of myocardial fibers. Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome. Hypertrophic cardiomyopathy involves asymmetric hypertrophy without ventricular dilation.

The nurse conducts a complete physical assessment on a patient admitted with suspected infective endocarditis (IE). Which diagnostic finding is indicative of the disorder? Heart rate of 50 Retinal hemorrhages Respiratory rate of 10 Feeling of impending doom

Retinal hemorrhages Rationale Retinal hemorrhages are associated with IE. A feeling of impending doom is not a clinical manifestation. Tachycardia and tachypnea are also clinical manifestations.

The ECG (electrocardiogram) of a postmenopausal woman reporting chest pain reveals an elevated ST segment, and the laboratory test reports indicate elevated cardiac biomarkers. Which condition does the nurse suspect? Dilated cardiomyopathy Restrictive cardiomyopathy Takotsubo cardiomyopathy Hypertrophic cardiomyopathy

Takotsubo cardiomyopathy Rationale Takotsubo cardiomyopathy is a transient cardiac syndrome that mimics acute coronary syndrome and is commonly observed in postmenopausal women. Dilated cardiomyopathy is characterized by reduced capacity to exercise, dyspnea at rest, and orthopnea. Restrictive cardiomyopathy involves orthopnea, angina, palpitations, and syncope. Hypertrophic is characterized by fatigue, exertional dyspnea, syncope, and angina.

The nurse is assessing a patient with chronic aortic regurgitation in the emergency unit of a health care facility. The nurse expects to find which heart sound? S 3 gallop Water-hammer pulse Loud accentuated S 1 Low-pitched diastolic murmur

Water-hammer pulse Rationale The nurse assessing a patient with chronic aortic regurgitation would find a strong, quick beat that collapses immediately, known as water-hammer pulse. Heart sounds may include a soft or absent S 1, S 3, or S 4 and a soft, high-pitched diastolic murmur. Low-pitched diastolic murmur and loud accentuated S 1 are observed in mitral valve stenosis. An S 3 gallop is found in patients with chronic mitral valve regurgitation.

When planning care for a pt at risk for PE the nurse prioritizes a. maintaining the pt on bed rest b. using SCDs c. encouraging the pt to cough & deep breathe d. teaching the pt how to use the incentive spirometer

b. using SCDs Prevent DVT

The nurse auscultates an irregular, rapid heart rate in a patient with mitral valve prolapse. Which type of medication does the nurse expect will be prescribed? Statin Nitrate β-blocker Anti-ischemic

β-blocker Rationale Palpitations are fast, hard, and irregular heartbeats. Propranolol is an example of a β-blocker that slows the heart rate by acting on the β-adrenergic receptors located on the heart cells. A statin, such as atorvastatin, is used primarily to treat elevated blood cholesterol levels and reduce the risk of cardiovascular disease. An anti-ischemic medication, such as trimetazidine, improves glucose control and improves cardiac function in dilated cardiomyopathy. A nitrate, such as isosorbide dinitrate, is used to prevent angina attacks by dilating blood vessels.